Abstract
BackgroundCardiovascular disease is a leading cause of death. It is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in general practice. This study investigates which patient and treatment factors are related to changes in cardiovascular risk estimation, expressed as the Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality.Methods179 general practice patients with mild-moderately elevated cardiovascular risk followed a one-year programme which included structured lifestyle and medication treatment by practice nurses, with or without additional self-monitoring. From the patient and treatment data collected as part of the “Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen” randomized controlled trial (SPRING-RCT), the contribution of patient and treatment factors to the change in SCORE was analysed with univariate and multivariate analyses.ResultsIn multivariate analyses with multiple patient and treatment factors, only SCORE at baseline, and addition of or dose change in lipid lowering or antihypertensive medications over the course of the study were significantly related to change in SCORE.ConclusionsOur analyses support the targeting of treatment at individuals with a high SCORE at presentation. Lipid lowering medication was added or changed in only 12% of participants, but nevertheless was significantly related to ΔSCORE in this study population. Due to the effect of medication in this practice-based project, the possible additional effect of the home monitoring devices, especially for individuals with no indication for medication, may have been overshadowed.Trial registrationtrialregister.nl NTR2188
Highlights
Cardiovascular disease is a leading cause of death
Men aged 50–75 years and women aged 55–75 years were enrolled in the study if they met the following criteria: 1) Estimated Systematic Coronary Risk Evaluation (SCORE) 10-year risk of cardiovascular mortality ≥5% [2]; 2) at least one treatable cardiovascular risk factor; and, 3) no history of Cardiovascular disease (CVD), diabetes mellitus, thyroid dysfunction or an estimated life expectancy
Estimated 10-year cardiovascular mortality risk according to SCORE** after one year minus estimated 10-year cardiovascular mortality risk at baseline
Summary
It is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in general practice. Strategies that are generally assumed to be effective include individualized risk assessment, risk communication and goal setting, and these are typically incorporated into national and international guidelines as well as research projects [6,7,8]. These elements formed part of the treatment in both study groups of the SPRING-RCT. Previous analysis of this data has revealed that total consultation time and the use of antihypertensive medication were higher in the intervention group [3]
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